Improving end-of-life care in nursing homes: Implementation and evaluation of an intervention to sustain quality of care

BackgroundPalliative care strives to improve quality of life for patients with incurable diseases. This approach includes adequate support of the patients’ loved ones. Consequently, loved ones have personal experiences of providing end-of-life care for their next. This is a resource for information and may help to investigate the loved ones’ perspectives on need for improvements.AimTo identify further quality aspects considered important by loved ones to improve the quality of care at the end of life as an addition to quantitative results from the Care of the Dying Evaluation for the German-speaking area (CODE-GER) questionnaire.DesignWithin the validation study of the questionnaire ‘Care of the Dying Evaluation’ (CODETM) GER, loved ones were asked to comment (free text) in parallel on each item of the CODE-GER. These free-text notes were analysed with the qualitative content analysis method by Philipp Mayring.Setting/participantsLoved ones of patients (n=237), who had died an expected death in two university hospitals (palliative and non-palliative care units) during the period from April 2016 to March 2017.Results993 relevant paragraphs were extracted out of 1261 free-text notes. For loved ones, important aspects of quality of care are information/communication, respect of the patient’s and/or loved one’s will, involvement in decision-making at the end of life (patient’s volition) and having the possibility to say goodbye.ConclusionsIt is important for loved ones to be taken seriously in their sorrows, to be informed, that the caregivers respect the patients’ will and to be emotionally supported.Trial registration numberThis study was registered at the German Clinical Trials Register (DRKS00013916).

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Do Palliative Care Teams in Nursing Homes Improve the Quality of End-of-Life Care for Nursing Home Residents?

10.25302/7.2019.cer.641 ◽

2019 ◽

Author(s):

Helena Temkin-Greener Helena Temkin-Greener ◽

Dana Mukamel ◽

Susan Ladwig ◽

Thomas , Caprio ◽

Sally Norton ◽

...

Keyword(s):

Palliative Care ◽

Nursing Home ◽

Nursing Homes ◽

End Of Life ◽

End Of Life Care ◽

Nursing Home Residents ◽

Life Care ◽

Palliative Care Teams

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Quality of cancer end-of-life care: discordance between bereaved relatives and professional proxies

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2019-002108 ◽

2020 ◽

pp. bmjspcare-2019-002108

Author(s):

Elisabetta Bertocchi ◽

Giovanna Artioli ◽

Elisa Rabitti ◽

Gabriele Bedini ◽

Silvia Di Leo ◽

...

Keyword(s):

Quality Of Care ◽

End Of Life ◽

Correlation Coefficient ◽

End Of Life Care ◽

Concordance Correlation Coefficient ◽

Consecutive Series ◽

Life Care ◽

Concordance Correlation ◽

Poor Agreement

BackgroundQuality of care for patients dying in hospital remains suboptimal. A major problem is the identification of valid sources of information about the views and experiences of dying patients and their relatives.AimThis study aimed to estimate the agreement on quality of end-of-life care from the perspectives of bereaved relatives, physicians and nurses interviewed after the patients’ death.DesignIn this prospective study, we interviewed, after the patient death, the bereaved relatives, the attending physicians and the reference nurses, using the Toolkit After-death Family Interview and the View Of Informal Carers-Evaluation of Services (VOICES). Agreement was assessed using Lin’s concordance correlation coefficient, Cohen’s kappa, overall concordance correlation coefficient and Fleiss’ kappa.Setting/participantsWe enrolled a consecutive series of 40 adult patients who died of cancer between January and December 2016 who had spent at least 48 hours in the medical oncology ward of the Santa Maria Hospital of Reggio Emilia, Italy.ResultsWe interviewed all physicians and nurses, and 26 (65.0%) out of 40 relatives. We found a poor agreement on overall quality of care among the three proxies (+0.21; −0.04 to 0.44), between relatives and nurses (+0.05; −0.39 to +0.47), and between relatives and physicians (+0.25; −0.13 to +0.57). A similar poor agreement was observed for all the other Toolkit and VOICES scales.ConclusionsThe agreement was rather poor, confirming previous results in different settings. Information from professional proxies should not be used for assessing the quality of care or for estimating missing information from bereaved relatives.

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Patients' participation in end-of-life care: Relations to different variables as documented in the patients' records

Palliative & Supportive Care ◽

10.1017/s1478951510000441 ◽

2010 ◽

Vol 8 (3) ◽

pp. 247-253 ◽

Cited By ~ 9

Author(s):

Irma Lindström ◽

Fannie Gaston-Johansson ◽

Ella Danielson

Keyword(s):

Quality Of Care ◽

End Of Life ◽

Cognitive Dysfunction ◽

End Of Life Care ◽

Healthcare Professionals ◽

Healthcare Services ◽

Life Care ◽

High Quality ◽

Care And Treatment

AbstractObjective:Patients' participation in care is crucial for assuring patients a high quality of care based on values such as autonomy. The patients are supposed to be actively involved in care and treatment, even though these situations are complex, as in the context of end-of-life-care. The aim in this study was to identify demographic and health-related variables‘ relation to patients’ participation during the last three months in life as documented in patients' records.Method:The population in the present study consists of 229 patients from 49 municipalities in a county in Sweden. Data were collected from all available documentation about deceased patients who were ≥18 years of age at the time of death and who had received healthcare services during the last 3 months of their life.Results:This article demonstrates patients' participation in end-of-life care as it was noted in the patients' documentation. Demographic variables such as age, gender, and residence did not differ between those who participated and those who did not. Patients with dementia and disorientation were separated from those who were not disoriented. There was no information about the wishes of the patients with dementia and disorientation and they were not described as participating in care and treatment. Cognitive intact patients were participating significant more often. These patients had also more symptom describes in the records. These results can indicate that a patient's participation depends upon either the patient's cognitive capability or the healthcare professionals' competence to communicate and provide adequate documentation regarding patients' participation at end-of-life. The documentation about the participation of patients with cognitive dysfunction is poor and needs further investigation, to achieve the goal of dignified end-of-life care for all patients.Significance of results:The results of the presents study call attention to the importance of finding innovative solutions to make patients with cognitive dysfunction involved in their care and treatment at end-of-life. Improvement of documentation showing patients' involvement in care is necessary, as is a discussion of how healthcare professionals can assure patients a high quality of care at end-of-life even if patients voices are not heard.

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Associations between Length of Stay in Long Term Care Facilities and End of Life Care. Analysis of the PACE Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17082742 ◽

2020 ◽

Vol 17 (8) ◽

pp. 2742 ◽

Cited By ~ 1

Author(s):

Danni Collingridge Moore ◽

Sheila Payne ◽

Thomas Keegan ◽

Luc Deliens ◽

Tinne Smets ◽

...

Keyword(s):

Quality Of Care ◽

End Of Life ◽

End Of Life Care ◽

Long Term Care ◽

Life Care ◽

Cross Sectional ◽

Term Care ◽

Care Facilities

Long term care facilities (LTCFs) are increasingly a place of care at end of life in Europe. Longer residence in an LTCF prior to death has been associated with higher indicators of end of life care; however, the relationship has not been fully explored. The purpose of this analysis is to explore associations between length of stay and end of life care. The analysis used data collected in the Palliative Care for Older People in care and nursing homes in Europe (PACE) study, a cross-sectional mortality follow-back survey of LTCF residents who died within a retrospective 3-month period, conducted in Belgium, England, Finland, Italy, the Netherlands and Poland. Primary outcomes were quality of care in the last month of life, comfort in the last week of life, contact with health services in the last month of life, presence of advance directives and consensus in care. Longer lengths of stay were associated with higher scores of quality of care in the last month of life and comfort in the last week of life. Longer stay residents were more likely to have advance directives in place and have a lasting power of attorney for personal welfare. Further research is needed to explore the underlying reasons for this trend, and how good quality end of life care can be provided to all LTCF residents.

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Importance of stratification when measuring quality of care: Results from the Project for an Ontario Women's Health Evidence-Based Report Card (POWER) study

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.6573 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 6573-6573

Author(s):

M. K. Krzyzanowska ◽

L. Barbera ◽

L. Elit ◽

R. Saskin ◽

N. Yeritsyan ◽

...

Keyword(s):

Quality Of Care ◽

End Of Life ◽

Low Income ◽

End Of Life Care ◽

Life Care ◽

Power Study ◽

Processes Of Care ◽

Delphi Approach

6573 Background: The goal of the POWER study is to improve health and reduce inequities among women of Ontario using population-based performance measurement. All selected indicators are stratified by sex, age, income and place of residence to determine whether there are disparities in performance associated with these factors. Results pertaining to cancer (CA) indicators are presented. Methods: A modified Delphi approach was used to identify performance measures spanning the disease spectrum from screening through follow-up care and feasible to be evaluated from administrative data. Most recently available data (2003–2005) from the Ontario Cancer Registry, Registered Persons, billing and hospital databases were then used to evaluate the selected measures stratified by above four factors. Results: Twenty-nine cancer-specific indicators were selected by the panel, majority of which related to processes of care: general indicators relevant to multiple cancers (3), screening (5), breast CA (5), lung CA (3), colorectal CA (4), gynecologic CA (4), and end-of-life care (5). Among measures relating to non-sex specific cancers, few sex-related differences in care were identified. Income-based differences in care were most pronounced among the screening indicators with individuals from low-income neighborhoods less likely to receive appropriate screening or follow-up after an abnormal screening test. Among measures relating to treatment, age was the factor most frequently associated with differences in care especially in regards to radiation- or chemotherapy-related processes of care. There were geographic differences in quality of care within the province along the entire trajectory of cancer care from screening through end-of-life care. Conclusions: Among the cancer quality indicators considered, few sex-based differences exist. However, factors such as age, income and where one lives are important predictors of care underscoring the importance of stratification by such factors when evaluating quality of care. Further work is necessary to determine whether these differences in processes of care affect outcomes and how to facilitate access to care by disadvantaged groups. No significant financial relationships to disclose.

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End-of-Life Care Discussion With COPD Patients Improves Quality of Care

Clinical Pulmonary Medicine ◽

10.1097/cpm.0b013e318271b8cf ◽

2012 ◽

Vol 19 (6) ◽

pp. 296-297

Author(s):

Aleksander Shalshin

Keyword(s):

Quality Of Care ◽

End Of Life ◽

End Of Life Care ◽

Life Care ◽

Copd Patients

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Older persons’ thoughts about death and dying and their experiences of end-of-life care: a qualitative study

10.21203/rs.3.rs-28054/v2 ◽

2020 ◽

Author(s):

Johanna Tjernberg ◽

Christina Bökberg

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Nursing Homes ◽

End Of Life ◽

End Of Life Care ◽

Older Persons ◽

Death And Dying ◽

Life Care ◽

Healthy Persons

Abstract Background: Few studies have focused on how older persons living in nursing homes perceive their last period of life. Furthermore, previous research on older persons’ perceptions of death and dying is limited. Hence, there is an urgent need to explore their experiences during their final period in life.Aim: To explore thoughts about death and dying and experiences of end-of-life care among older persons living in nursing homes.Methods: This study employed a qualitative approach including individual interviews with 36 older persons living in Swedish nursing homes. Questions related to quality of life; physical health; thoughts about death, dying, and the future; and experiences related to the living condition and environment were asked. The interview transcripts were analysed through content analysis. The study was approved by the Regional Ethics Review Board (reference number: 2015/4).Results: The analysis resulted in the identification of three main thematic categories: The unavoidable and unknown end of life, Thoughts on control and Living your last period of life at a nursing home. The older persons did not fear death itself but had some worries about dying. Spending the last stage of life at a nursing home contributed to different thoughts and feelings among the older persons. With a few exceptions, older persons characterized life at the nursing home as boring and felt they were surrounded by people who did not belong there.Conclusions: This study indicates a need for older persons to talk about death, dying and end-life issues. Furthermore, this study highlighted that the co-residence of cognitively healthy persons and persons with dementia in the same ward adversely affected cognitively healthy persons. This situation resulted in there being not enough time to both handle the care needs of persons with dementia and have the conversations that cognitively healthy persons desired, such as conversations about thoughts about existence, that could have improved their quality of life.Trial registration: NCT02708498 Date of registration 16 February 2016.

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